Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.
IHU-Méditerranée Infection, Marseille, France.
BMC Public Health. 2020 May 12;20(1):658. doi: 10.1186/s12889-020-08792-5.
The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers' presentation of vaccination cards.
The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years, with a questionnaire focusing on children's health. This analysis was restricted to children aged 12-35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months).
Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5-10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers' attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on.
Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.
世界卫生组织建议在行政报告系统不够可靠的国家，根据产妇回忆来记录疫苗接种情况，因为与疫苗接种卡上的数据相比，发展中国家产妇回忆的疫苗接种情况相当可靠。本研究旨在根据母亲出示的疫苗接种卡来调查儿童疫苗接种覆盖率及其决定因素。
数据来自 2017 年塞内加尔人口与健康调查，这是一项针对 15-49 岁妇女的全国代表性家庭调查，调查问卷重点关注儿童健康。本分析仅限于 12-35 月龄的儿童（n=4032），并使用加权多变量逻辑回归评估了疫苗接种覆盖率及其相关社会人口因素。还进行了分层多变量逻辑回归，以调查与卡介苗（出生后不久推荐接种）以及黄热病和麻疹（推荐在 9 个月龄时接种）常规儿童免疫接种的相关因素。
根据疫苗接种卡或父母回忆评估的疫苗接种覆盖率估计值之间存在 5-10%的差异，卡介苗、五联疫苗、麻疹和黄热病疫苗的估计覆盖率差异较大，但脊灰疫苗的差异巨大（有卡时为 93.0%，无卡时为 32.0%）。出示疫苗接种卡与母亲到医疗机构就诊的情况相关（表明它是母亲与医疗保健系统之间联系的具体体现），与母亲的居住地有关，但与儿童疫苗接种的通常重要预测因素（如母亲的教育水平）无关。与疫苗接种相关的因素因疫苗接种是在出生后不久还是稍后进行而有所不同。
除了口服脊灰疫苗外，产妇回忆被发现相当可靠，这表明由于对注射和接种之间的混淆，完全免疫覆盖率可能被大大低估。考虑到出示疫苗接种卡作为与医疗保健系统联系的体现，那些缺乏这种联系的人在决定接种疫苗时，决策过程似乎更长，更有可能受到供应方的影响。
